M. Santos

Prospective Coronary Heart Disease Screening in Asymptomatic Hodgkin Lymphoma Patients Using Coronary Computed Tomography Angiography: Results and Risk Factor Analysis

PURPOSE To prospectively investigate the coronary artery status using coronary CT angiography (CCTA) in patients with Hodgkin lymphoma treated with combined modalities and mediastinal irradiation. METHODS AND MATERIALS All consecutive asymptomatic patients with Hodgkin lymphoma entered the study during follow-up, from August 2007 to May 2012. Coronary CT angiography was performed, and risk factors were recorded along with leukocyte telomere length (LTL) measurements. RESULTS One hundred seventy-nine patients entered the 5-year study. The median follow-up was 11.6 years (range, 2.1-40.2 years), and the median interval between treatment and the CCTA was 9.5 years (range, 0.5-40 years). Coronary artery abnormalities were demonstrated in 46 patients (26%). Coronary CT angiography abnormalities were detected in nearly 15% of the patients within the first 5 years after treatment. A significant increase (34%) occurred 10 years after treatment (P=.05). Stenoses were mostly nonostial. Severe stenoses were observed in 12 (6.7%) of the patients, entailing surgery with either angioplasty with stent placement or bypass grafting in 10 of them (5.5%). A multivariate analysis demonstrated that age at treatment, hypertension, and hypercholesterolemia, as well as radiation dose to the coronary artery origins, were prognostic factors. In the group of patients with LTL measurements, hypertension and LTL were the only independent risk factors. CONCLUSIONS The findings suggest that CCTA can identify asymptomatic individuals at risk of acute coronary artery disease who might require either preventive or curative measures. Conventional risk factors and the radiation dose to coronary artery origins were independent prognostic factors. The prognostic value of LTL needs further investigation.

Intraoperative and external beam radiotherapy in invasive bladder cancer: pathological findings following cystectomy.

The pathological findings observed following intraoperative radiotherapy (IORT) boost (15Gy) to the whole bladder, external beam fractionated irradiation (46Gy in 5 weeks), and planned radical cystectomy in patients with deep invasive bladder carcinoma are analyzed. Clinical pretreatment stage of disease was T3 (16 cases) and T4 (two cases). No evidence of residual tumor (pT0) was demonstrated in 11 cystectomy specimens (61%) and residual tumor (pT1) was observed in seven (39%). Toxicity and complications related to the treatment approaches were minor and reversible. It is concluded that IORT is a feasible boosting modality in the management of invasive bladder cancer, able to induce high rates of pT0 cystectomy specimens, and might be considered as a valuable technique for organ preservation treatment programs.

IORT for CNS Tumors

High-grade malignant gliomas are the most common brain tumors of the adult life and account for about 30–45% of the primary human brain tumors. Of these, nearly 85% are glioblastoma multiforme (1).

El control de calidad en los tratamientos de radiocirugía. Recomendaciones metodológicas

Resumen La radiocirugia estereotaxica es una tecnica neuroquirurgica utilizada para el tratamiento de malformaciones arteriovenosas y de algunos tumores cerebrales. Se basa en la administracion de una dosis de radiacion, con gran exactitud y muy concentrada, en el volumen patologico. Utiliza diversos equipamientos: un sistema esterotaxico de localizacion espacial, equipos de identificacion de la lesion -TAC, RM o angiografia-; un sistema computarizado de planificacion y dosimetria, un sistema de posicionamiento del paciente y el sistema de irradiacion. Las caracteristicas del procedimiento de radiocirugia, donde el cumplimiento de una metodologia es basico, hacen conveniente la utilizacion de un protocolo de tratamiento, que a la vez sirva de control de calidad. El protocolo que se presenta ha sido utilizado en 300 casos tratados en la Unidad de Radiocirugia del Sanatorio San Francisco de Asis de Madrid. Esta dividido en 8 fases: recopilacion de datos e identificacion; colocacion de la guia estereotaxica, realizacion de TAC cerebral, angiografia cerebral (en malformaciones arteriovenosas), procesamiento e integracion de imagenes, planificacion y dosimetria, instalacion del equipamiento de radiocirugia en el acelerador lineal y tratamiento. Se destaca la necesidad de actuacion coordinada de los distintos especialistas –neurocirujanos, radioterapeutas, radiofisicos, neuroradiologos, informaticos, tecnicos operadores y de mantenimiento, ATS especializados, etc.– y de la disponibilidad de los equipos de diagnostico, planificacion y tratamiento.